RESUMEN
Diabetes exerts a major economic impact on healthcare in the United States both in terms of direct and indirect costs. Diabetes management and education programs designed to assist patients in achieving more optimal glycemic control represent a potential mechanism for reducing the morbidity and costs associated with diabetes. The relationship between HbA1c and patient hospitalizations and between HbA1c and days lost from work or school related to diabetes within the past year were evaluated. A cohort of 2359 patients with diabetes (188 type I, 2171 type II) referred to a comprehensive diabetes self-management training program was included in the analyses. Overall, 350 (14.8%) patients reported hospitalization, and 212 (9.0%) reported days lost from work or school. Patients with type I diabetes reported more hospitalizations (26.1% vs 13.9% and days lost (19.2% vs 8.1%) than type II patients. For the hospitalization outcome, the multivariate analyses indicated that younger age, the number of co-morbidities, and the duration of diabetes exerted a greater influence on the reported numbers of hospitalization than glycemic control. For the days lost outcome, the multivariate analyses indicated that there was a marginally significant association between patients with poor glycemic control and reported work or school loss related to diabetes (odds ratio = 1.5; 95% confidence interval, 1.0-2.2). These data suggest that interventions that improve glycemic control may decrease indirect costs related to diabetes.
Asunto(s)
Absentismo , Costo de Enfermedad , Diabetes Mellitus/economía , Educación del Paciente como Asunto/organización & administración , Adulto , Anciano , Estudios de Cohortes , Diabetes Mellitus/terapia , Manejo de la Enfermedad , Empleo , Femenino , Hemoglobina Glucada/análisis , Investigación sobre Servicios de Salud , Hospitalización , Humanos , Masculino , Programas Controlados de Atención en Salud , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Educación del Paciente como Asunto/normas , Autocuidado , Estudiantes , Estados UnidosRESUMEN
OBJECTIVE: To determine whether prophylactic treatment with ursodeoxycholic acid can prevent gallstone formation in persons participating in a very-low-calorie weight reduction diet program. DESIGN: Multicenter, double-blind, placebo-controlled, multidose clinical trial. Patients were treated with placebo or with 300 mg/d, 600 mg/d, or 1200 mg/d of ursodeoxycholic acid. SETTING: 31 Health Management Resources weight management centers. PATIENTS: 1004 patients were initially enrolled in a 16-week, 520-kcal/d, Health Management Resources liquid protein diet program. All patients had a body mass index of 38 kg/m2 or more and a normal gallbladder ultrasonogram before study entry. Bile analysis was done in 32 patients. MEASUREMENTS: Body weight and body mass index were measured before the diet was started and at 2-week intervals for 16 weeks. Gallbladder ultrasonography was done before enrollment and after 8 and 16 weeks of dieting. Bile was obtained by endoscopy and analyzed for cholesterol crystals and lipid levels. RESULTS: Mean body weight for all patients at the start of dieting was 128.2 kg +/- 23.2 kg; mean initial body mass index was 44.2 kg/m2 +/- 6.0 kg/m2. Gallstones developed in 28% (95% CI, 22% to 35%) of patients receiving placebo, in 8% (CI, 5% to 13%) of patients treated with 300 mg/d of ursodeoxycholic acid, in 3% (CI, 1% to 7%) of patients treated with 600 mg/d of ursodeoxycholic acid, and in 2% (CI, 0.5% to 5%) of patients treated with 1200 mg/d of ursodeoxycholic acid. The differences between patients receiving placebo and patients receiving ursodeoxycholic acid were statistically significant. The percentage of ursodeoxycholic acid in bile increased stepwise with increasing doses of ursodeoxycholic acid. CONCLUSIONS: Ursodeoxycholic acid, 600 mg/d, is highly effective in preventing gallstone formation in patients having dietary-induced weight reduction.
Asunto(s)
Colelitiasis/prevención & control , Dieta Reductora , Ácido Ursodesoxicólico/uso terapéutico , Adolescente , Adulto , Anciano , Bilis/química , Índice de Masa Corporal , Colesterol/análisis , Cristalización , Método Doble Ciego , Ingestión de Energía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Ácido Ursodesoxicólico/efectos adversos , Pérdida de PesoRESUMEN
OBJECTIVES: This study critically examined the relationships between weight loss and changes in serum lipid and blood pressure levels. DESIGN: Eighty morbidly obese women and men were treated with an intensive very-low-calorie diet (VLCD) and behavioral education program. Body weight and blood pressure were measured weekly. Serum lipids were measured biweekly. RESULTS: Patients lost an average of 35.3 kg in 25.6 weeks. These values decreased significantly: fasting serum cholesterol, 15.1%; low density lipoprotein cholesterol, 17.0%; triglycerides, 14.2%; systolic blood pressure, 8.7%; and diastolic blood pressure, 10.2%. Changes in serum lipids and blood pressure were significantly (p < 0.001) correlated with baseline values and with changes in body mass index (BMI) after adjustment for baseline values. Patients maintained an average of 19.7 kg of their weight loss at the 2-year follow-up. CONCLUSIONS: Weight reduction through a multidisciplinary VLCD program significantly reduces risk factors for cardiovascular disease; for morbidly obese individuals, improvements in risk factors were significantly and linearly related to changes in the BMI.
Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Obesidad Mórbida/dietoterapia , Pérdida de Peso , Adulto , Presión Sanguínea , Índice de Masa Corporal , Dieta Reductora , Femenino , Estudios de Seguimiento , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Factores de RiesgoRESUMEN
OBJECTIVE: This study was designed to determine if food-containing hypocaloric diets are as effective as liquid-supplement diets in promoting weight loss for obese individuals with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Forty NIDDM subjects with body mass indexes (BMIs) of 30-40 kg/m2 were randomized to one of two 800-kcal diets for 12 weeks. Group A received liquid supplement only, and group B received supplement plus an evening meal. Both groups received an intensive behavioral education program. RESULTS: Weight loss and improvements in glycemic, blood lipid, and blood pressure parameters were similar for the two groups. Weight loss averaged 15.7 kg for the entire group. The need for insulin, anti-diabetes, and anti-hypertensive medication decreased significantly. No serious side effects were observed. CONCLUSIONS: Both food-containing and supplement diets providing 800 kcal a day effectively promote weight loss for obese individuals with NIDDM.
Asunto(s)
Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus/dietoterapia , Dieta Reductora , Alimentos Fortificados , Obesidad , Índice de Masa Corporal , Peso Corporal , Diabetes Mellitus/sangre , Diabetes Mellitus/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Ingestión de Energía , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
Comprehensive very-low-calorie diet (VLCD) programs are the preferred treatment for selected obese individuals. They combine energy intakes of 400-800 kcal/day with medical monitoring and intensive lifestyle education. Typical VLCD patients have median body mass indexes of 36 kg/m2 and have median ages of 40 years. About 70% are female. Commonly associated medical problems include hypertension in 50%, hyperlipidemia in 41%, and diabetes mellitus or glucose intolerance in 14%. Typical weight loss with VLCD is around 21 kg in 16 wk. Reductions of 8-13% in blood pressure, 5-15% in serum total cholesterol, 5-20% in low-density lipoprotein-cholesterol, 15-50% in triglycerides, and decreases in blood glucose and glycohemoglobin in diabetic individuals accompany weight loss. VLCD-associated side effects can be managed medically without discontinuing treatment. Lifestyle education promotes long-term weight maintenance of approximately 56% 2 yr after VLCD treatment. Weight losses using comprehensive VLCDs allow moderately to morbidly obese persons to achieve greater benefits than other nonsurgical treatments and should be considered before opting for surgical treatment.